Interdisciplinary Neurosurgery (Sep 2021)
Gilchrist disease of the central nervous system mimicking malignant brain neoplasm: A rare and fatal complication of blastomyces dermatitidis: Diagnostic and therapeutic challenge
Abstract
Blastomycosis or “Gilchrist disease” is a deep mycosis due to a dimorphic fungus: “Blastomyces Dermatitidis (B.D).” It is a telluric fungus of the wooded areas of the Eastern North American continent, causing chronic granulomatous diseases, responsible for pulmonary manifestations due to the inhalation of its spores. Dissemination can lead to skin, bone, visceral, and even neurological signs that can be fatal.The authors report the case of a 50-year-old African man who has been complaining for five days before admission of headaches and behavioral disorders. On examination, he had a frontal lobe syndrome with idiopathic slowdown without motor or sensory deficit. The rest of his check up was normal. Cerebral magnetic resonance imaging showed a left retro-orbital frontobasal lesion with intense enhancement. The postoperative course was marked by the absence of awakening and the patient's death in the intensive care unit. Histopathological examination has concluded to cerebral blastomycosis.Extra-pulmonary blastomycosis remains a rare entity. The diagnosis is mainly based on examination of the cerebrospinal fluid or the specimen after special staining. The mild or moderate forms are treated with itraconazole. In the case of severe, life-threatening infection, amphotericin B is required. The prognosis is unfortunately reserved for the price of several complications.
